Hiv Pathophysiology Essay Example

Hiv Pathophysiology Essay Pathophysiology of the human immunodeficiency virus Nancy R. Calles, MSN, RN, PNP, ACRN, MPH Desiree Evans, MD, MPH DeLouis Terlonge, MD Objectives 1. 2. 3. 4. 5. Provide an overview of the healthy immune system. Describe the human immunodeficiency virus (HIV). Describe the major components of the HIV life cycle. Identify the various HIV types and subtypes. Discuss HIV’s effects on the immune system. Overview The human immunodeficiency virus (HIV) is a retrovirus belonging to the family of lentiviruses. Retroviruses can use their RNA and host DNA to make viral DNA and are known for their long incubation periods. Like other retroviruses, HIV infects the body, has a long incubation period (clinical latency), and ultimately causes the signs and symptoms of disease, here AIDS. HIV causes severe damage to the immune system and eventually destroys it by using the DNA of CD4+ cells to replicate itself. In that process, the virus eventually destroys the CD4+ cells. Key Points 1. The immune system protects the body by recognizing invading antigens on pathogens (bacteria, viruses, fungi, and parasites) and reacting to them. 2. T lymphocytes, or T cells, regulate the immune system and destroy antigens. . HIV continuously uses new host cells to replicate itself. 4. The HIV life cycle includes six phases: binding and entry, reverse transcription, integration, replication, budding, and maturation. 5. Once HIV is in the circulatory system, it targets the CD4+ lymphocyte. 6. Two types of HIV cause AIDS: HIV type 1 (HIV-1) and HIV-2. 7. Primary infection refers to the time when HIV first enters the body. 8. Clinical latency refers to the time before onset of symptoms and complications in the HIV-infected individual. In HIV-infected adults, this phase may last 8-10 years. 9. We will write a custom essay sample on Hiv Pathophysiology specifically for you for only $16.38 $13.9/page Order now We will write a custom essay sample on Hiv Pathophysiology specifically for you FOR ONLY $16.38 $13.9/page Hire Writer We will write a custom essay sample on Hiv Pathophysiology specifically for you FOR ONLY $16.38 $13.9/page Hire Writer Early signs and symptoms of HIV can include candidiasis, lymphadenopathy, cervical carcinoma, herpes zoster, and peripheral neuropathy. 10. Late signs and symptoms of HIV and AIDS-defining illnesses can include the development of lifethreatening infections and malignancies. The Healthy Immune System The immune system protects the body by recognizing antigens on invading bacteria and viruses and reacting to them. An antigen is any substance that induces a state of sensitivity and immune responsiveness. These antigens interact with antibodies and immune cells, initiating an immune response. This process destroys the antigen, allowing the body to be free of infections. Types of antigens include bacteria, viruses, fungi, and parasites. When the immune system is weakened or destroyed by a virus such as HIV, the body is left vulnerable to infections. The immune system consists of lymphoid organs and tissues, including the bone marrow, thymus gland, lymph nodes, spleen, tonsils, adenoids, appendix, blood, and lymphatic vessels (Figure 1). All components of the immune system are vital in the production and development of lymphocytes, or white blood cells. B lymphocytes (or B cells) and T lymphocytes (or T cells) are produced from stem cells in the bone marrow. B cells stay in the bone marrow to complete the maturation process, but T lymphocytes travel to the thymus gland to complete their maturation. There T lymphocytes become immunocompetent, multiply, and become more differentiated. 7 HIV Curriculum for the Health Professional cells, T-suppressor cells, inhibits or suppresses immune responses. Normal CD8+ cell count is between 300 and 1,000 cells in adults and children. The normal CD4+:CD8+ ratio is between 1. 0 and 2. . T cells can secrete cytokines (chemicals that kill cells), such as interferon. Cytokines can bind to target cells and activate the inflammatory process. They also promote cell growth, activate phagocytes, and destroy target cells. Interleukins are cytokines that serve as messengers between white blood cells. Recombinant (laboratory synthesized) interleukins are currently being studied in clinical trials for patients with HIV infection. Tonsils and Adenoids Thymus Lymph Nodes Spleen Peyer’s Patches Appendix Bone Marrow Lymph Nodes Lymphatic Vessels Phagocytes Phagocytes include monocytes and macrophages, large white blood cells that engulf and digest cells carrying antigenic particles. Found throughout the body, phagocytes rid the body of worn-out cells, initiate the immune response by presenting antigens to lymphocytes, are important in immune response regulation and inflammation, and carry receptors for cytokines. Dendritic cells, another type of phagocyte, also are antigen-presenting cells. They have long, threadlike extensions that help trap lymphocytes and antigens and are found in the spleen and lymph nodes. Neutrophils are granulocytic phagocytes that are important in the inflammatory response. Figure 1. Organs of the Immune System B Lymphocytes The main function of B lymphocytes is humoral (antibody) immunity. Each B cell can recognize specific antigen targets and can secrete specific antibodies. Antibodies function by coating antigens, which makes the antigens more vulnerable to phagocytosis (engulfing and ingestion of invading organisms by leukocytes and/ or macrophages), or by triggering the complement system, leading to an inflammatory response. Antibodies are highly specialized serum protein molecules. They are grouped into five classes, each having a specialized function: immunoglobulin G (IgG), IgA, IgM, IgE, and IgD. Complement The complement system consists of 25 proteins. Complement can induce an inflammatory response when it functions with antibodies to facilitate phagocytosis or weaken the bacterial cell membrane. The complement proteins interact with one another in a sequential activation cascade, promoting the inflammatory process. Despite the heavy artillery that the immune system has against foreign predators (Figures 2 and 3), HIV defeats it over time. T Lymphocytes T lymphocytes have two major functions: regulation of the immune system and killing of cells that bear specific target antigens. Each T cell has a surface marker, such as CD4+, CD8+, and CD3+, that distinguishes it from other cells. CD4+ cells are helper cells that activate B cells, killer cells, and macrophages when a specific target antigen is present. There are two main types of CD8+ cells. The first type, cytotoxic CD8+ cells, kills cells infected by viruses or bacteria, as well as cancer cells. The second type of CD8+ 8 HIV’s Structure HIV consists of a cylindrical center surrounded by a sphere-shaped lipid bilayer envelope. There are two major viral glycoproteins in this lipid bilayer, gp120 and gp41. The major function of these proteins is to mediate recognition of CD4+ cells and chemokine receptors, thereby enabling the virus to attach to and invade CD4+ cells. The inner sphere contains two single-stranded Pathophysiology of the Human Immunodeficiency Virus Stem Cell Lymphoid Precursor Platelets Myeloid Precursor Helper T-Cell Eosinophil Monocyte H-Cell Cytotoxic T-Cell Suppressor T-Cell Neutrophil Mast Cell Basophil Macrophage Plasma Cell Figure 2. Cells of the immune system White Blood Cells Neutrophils Lymphocytes Eosinophils Basophils B-Cells T-Cells CD4+ CD8+ In charge of the army Summons B-cells, natural killer (NK) cells, macrophages Plans for a direct attack Binds directly to antigen and kills it Figure 3. Immune response by white blood cells 9 HIV Curriculum for the Health Professional copies of the genomic material, RNA, as well as multiple proteins and enzymes necessary for HIV replication and maturation: p24, p17, reverse transcriptase, integrase, and protease (Figure 4). Unlike other retroviruses, HIV uses nine genes to code for the necessary proteins and enzymes. The three principal genes are gag, pol, and env. The gag gene encodes core proteins. The pol gene encodes the enzymes reverse transcriptase, protease, and integrase. The env gene encodes the HIV structural components known as glycoproteins. The rest of the genes—rev, nef, vif, vpu, vpr, and tat—are important for viral replication and enhancing HIV’s infectivity rate. cells make their way to the lymph nodes and eventually to the peripheral blood, where viral replication becomes rapid. CD4+ lymphocytes that are recruited to respond to viral antigen migrate to the lymph nodes. These become activated and then proliferate via complex interaction of cytokines released in the microenvironment of the lymph nodes. This sequence of events makes the CD4+ cells more susceptible to HIV infection, and it explains the generalized lymphadenopathy characteristic of the acute retroviral syndrome seen in adults and adolescents. In contrast, HIV-infected monocytes allow viral replication but resist killing. Thus, monocytes act as reservoirs of HIV and as effectors of tissue damage in organs such as the brain. The HIV life cycle includes six phases: binding and entry, reverse transcription, integration, replication, budding, and maturation (Figure 5). HIV’s Life Cycle Host cells infected with HIV have a shortened life span as a result of the virus’s using them as â€Å"factories† to produce multiple copies of new HIV. Thus, HIV continuously uses new host cells to replicate itself. As many as 10 million to 10 billion virions (individual viruses) are produced daily. In the first 24 h after exposure, HIV attacks or is captured by dendritic cells in the mucous membranes and skin. Within 5 days after exposure, these infected Binding and Entry The envelope proteins gp120 and gp41 bind to CD4+ cell receptors and coreceptors on the outside of CD4+ cells HIV Structure Envelope Envelope Proteins gp120 gp41 Matrix Proteins p17 Core Proteins p14 RT RNA Integrase Protease Figure 4. The Human Immunodeficiency Virus 10 Pathophysiology of the Human Immunodeficiency Virus sCD4 CD4-lgG Reverse Transcriptase Inhibitors Zidovudine Didanosine Zalcitabine Stavudine Lamivudine Nevirapine Reverse transcription Protease Inhibitors Saquinavir Indinavir Ritonavir Nelfinavir Tat Antagonists Penetration Uncoating Trans- TransIntegration cription lation Assembly Release HIV HIV Double-stranded unintegrated DNA cDNA Host chormosome Proviral DNA CD4 and chemokine receptors Genomic RNA Viral mRNA Nucleus Cytoplasm Figure 5. The HIV life cycle This depiction of the HIV life cycle shows the sites of action of some antiretroviral agents. and macrophages. The chemokine receptors CCR5 and CXCR4 facilitate viral entry. T-cell tropic viruses require CXCR4 to bind, and macrotropic strains of the virus require CCR5. R5 is the most common virus transmitted during acute infection, and later during infection X4 is the virus that is most common. The presence of a homozygous inactive mutation of the CCR5 allele has caused resistance to infection by the R5 virus. The joining of the proteins and the receptors and coreceptors fuses the HIV membrane with the CD4+ cell membrane, and the virus enters the CD4+ cell and macrophage. The HIV membrane and the envelope proteins remain outside of the CD4+ cell, whereas the core of the virus enters the CD4+ cell. CD4+ cell enzymes interact with the viral core and stimulate the release of viral RNA and the viral enzymes reverse transcriptase, integrase, and protease. incorporation must occur for the virus to multiply. The conversion of HIV RNA to DNA is known as reverse transcription and is mediated by the HIV enzyme reverse transcriptase. The result is the production of a single strand of DNA from the viral RNA. The single strand of this new DNA then undergoes replication into doublestranded HIV DNA. Integration Once reverse transcription has occurred, the viral DNA can enter the nucleus of the CD4+ cell. The viral enzyme integrase then inserts the viral DNA into the CD4+ cell’s DNA. This process is known as integration. The CD4+ cell has now been changed into a factory used to produce more HIV. Replication The new DNA, which has been formed by the integration of the viral DNA into the CD4+ cell, causes the production of messenger DNA that initiates the synthesis of HIV proteins. Reverse Transcription The HIV RNA must be converted to DNA before it can be incorporated into the DNA of the CD4+ cell. This 11 HIV Curriculum for the Health Professional Budding The HIV proteins and viral RNA, all the components needed to make a new virus, gather at the CD4+ cell membrane to form new viruses. These new viruses push through the different parts of the cell wall by budding. Many viruses can push through the wall of one CD4+ cell. These new viruses leave the CD4+ cell and contain all the components necessary to infect other CD4+ cells. Subtypes are unevenly distributed throughout the world. Subtype C currently accounts for more than half of all new HIV infections worldwide. Africa has most subtypes, although subtype B is less prevalent. There are no known subtypes of HIV-2. Effects on the Immune System The pathogenesis of HIV is basically a struggle between HIV replication and the immune responses of the patient, via cell-mediated and immune-mediated reactions. The HIV viral burden directly and indirectly mediates CD4+ T-cell destruction. There is destruction of mature CD4+ cells; CD4+ progenitor cells in bone marrow, the thymus, and peripheral lymphoid organs; as well as CD4+ cells within the nervous system, such as microglia. The result of this destruction is failure of T-cell production and eventual immune suppression. There are many mechanisms of CD4+ cell depletion by HIV infection. Direct HIV-mediated cytopathic effects include single-cell killing as well as cell fusion, or syncytium formation. The syncytium is a fusion of multiple uninfected CD4+ cells with one HIV-infected CD4+ cell via CD4–gp120 interaction. This fusion results in a multinucleated syncytium, or giant cell, which may ultimately serve as a means to produce many virions. The host’s natural immune responses also play a role in CD4+ cell depletion, mainly through cytotoxic CD8+ T-cells, antibody-dependent cellular cytotoxicity, and natural killer cells. Other mechanisms include autoimmune responses, anergy, superantigen-mediated activation of T cells, and programmed cell death (apoptosis). HIV can infect many types of cells. The spread of HIV outside lymphoid organs to the brain, spinal cord, lung, colon, liver, and kidney usually occurs late during illness. Table 1 gives a partial list of cells susceptible to HIV infection. The immune systems of HIV-infected children undergo changes that are similar to those in adults. B-cell activation occurs in most children early in the infection, evidenced by the presence of hypergammaglobulinemia (gt;1. 750 g/L) with high levels of anti–HIV-1 antibody. This reflects both dysregulation of T-cell suppression of B-cell antibody synthesis as well as active CD4+ enhancement of B-lymphocyte humoral response. Also, as HIV disease progresses through more severe immunosuppression and depletion of CD4+ cells, the CD8+ count increases, yielding an overall decrease in the CD4+:CD8+ ratio. Maturation The new virus has all the components necessary to infect other CD4+ cells but cannot do so until it has matured. During this process, the HIV protease enzyme cuts the long HIV proteins of the virus into smaller functional units that then reassemble to form a mature virus. The virus is now ready to infect other cells. HIV Types There are two types of HIV that cause AIDS: HIV type 1 (HIV-1) and HIV-2. We know little about HIV-2. Studies have shown striking similarities but also important differences between HIV-1 and HIV-2. They have the same modes of transmission and are associated with the same opportunistic infections, but HIV-2 appears to progress more slowly. Most HIV-2 cases are found in western Africa and in countries related to western Africa in some way such as Portugal, France, Angola, Mozambique, Brazil, and India. Various subtypes of HIV-1 have been found in specific geographic areas and in specific high-risk groups. A person can be coinfected with different subtypes. The following are HIV-1 subtypes and their geographic distributions: Subtype A: Central Africa, sub-Saharan Africa Subtype B: South America, Brazil, United States, Thailand, Europe, Caribbean, India, Japan Subtype C: Brazil, India, South Africa Subtype D: Central Africa, sub-Saharan Africa Subtype E: Thailand, Central African Republic, Southeast Asia Subtype F: Brazil, Romania, Democratic Republic of Congo (Zaire) Subtype G: Democratic Republic of Congo (Zaire), Gabon, Thailand, Russia, Central Africa Subtype H: Democratic Republic of Congo (Zaire), Gabon, Russia, Central Africa Subtype I: Cyprus Subtype O: Cameroon, Gabon 12 Pathophysiology of the Human Immunodeficiency Virus Table 1. Cells Susceptible to HIV Infection System Hematopoietic Cell †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ †¢ T-cells (CD4+ OR CD 8+) Macrophages/monocytes Dendritic cells Fetal thymocytes and thymic epithelium B-cells NK cells Megakaryotic cells Stem cells Microglia Capillary endothelial cells Astrocytes Oligodendrocytes differentiating symptom that is often absent is the presence of a runny nose or nasal congestion. During primary infection, the CD4+ count in the blood decreases remarkably but rarely drops to less than 200 cells/? L. The virus targets CD4+ cells in the lymph nodes and the thymus during this time, making the HIV-infected person vulnerable to opportunistic infections and limiting the thymus’s ability to produce T lymphocytes. HIV antibody testing using an enzymelinked immunosorbent assay or enzyme immunoassay may yield positive or negative results depending on the time of seroconversion. DNA PCR and RNA PCR will be positive, but confirmation with Western blot analysis may yield an indeterminate result because seroconversion can take up to 2–8 weeks to occur. The average time to seroconversion is 25 days. Central Nervous Large Intestine Other †¢ Columnar epithelium †¢ Kupfer cells (liver †¢ Synovial cells †¢ Placental tophoblast cells Clinical Latency/Asymptomatic Disease (Clinical Stage 1) Although patients recently infected with HIV usually experience a â€Å"clinically latent† period of years between HIV infection and clinical signs and symptoms of AIDS, evidence of HIV replication and host immune system destruction exists from the onset of infection. Early during this time, referred to as Clinical Stage 1 , the immune system produces antibodies in an attempt to protect itself from HIV. This is when the â€Å"viral set point† is established. The viral load of the set point can be used to predict how quickly disease progression will occur. People with higher viral load set points tend to exhibit more rapid disease progression than those with lower viral load set points. During latency, HIV-infected patients may or may not have signs and symptoms of HIV infection though persistent lymphadenopathy is common. In HIVinfected adults, this phase may last 8–10 years. The HIV enzyme-linked immunosorbent assay and Western blot or immunofluorescence assay will be positive. The CD4+ count is greater than 500 cells/? L in children over 5 years of age. Adapted from Levy L. A. Microbiological Reviews, 57:183-289, March 1993 Clinical Categories of HIV Infection Children infected with HIV often have severe disease when first evaluated, or they may develop AIDS over time, much like adults infected with HIV. Infants and young children normally have higher CD4+ counts than those of adults. The normal CD4+ count in children varies with age, but it is equal to the adult value by the time the child is 6 years old. Immunologic and clinical categories are used to evaluate the HIV disease status in children and to make treatment decisions. Primary Infection, or Acute Retroviral Syndrome Primary infection refers to the time when HIV first enters the body. At the time of primary infection with HIV, a person’s blood carries a high viral load, meaning that there are many individual viruses in the blood. The number of copies of virus per milliliter of plasma or blood can exceed 1 million. Newly infected adults often experience an acute retroviral syndrome. Signs and symptoms of acute retroviral syndrome include fever, myalgia (muscle pain), headache, nausea, vomiting, diarrhea, night sweats, weight loss, and rash. These signs and symptoms usually occur 2–4 weeks after infection, subside after a few days, and often are misdiagnosed as influenza or infectious mononucleosis. An important Mild Signs and Symptoms of HIV (Clinical Stage 2) HIV-infected people may appear to be healthy for years, and then minor signs and symptoms of HIV infection begin to appear. They may develop candidiasis, lymphadenopathy, molluscom contagiosum, persistent 13 HIV Curriculum for the Health Professional hepatosplenomegaly, popular pruritic eruptions, herpes zoster, and/or peripheral neuropathy. The viral load increases, and the CD4+ count falls is between 350-499/ uL in children older than 5 years. Once patients are in this stage they remain in stage 2. They can be reassigned stage 3 or 4 if a condition from one of those occurs, but they cannot be reassigned to Clinical Stage 1 or 2 if they become asymptomatic. References 1. Behrman RE, Kliegman RM, Jenson HB. Nelson Textbook of Pediatrics. Philadelphia: W. B. Saunders; 2004. 2. Bullock BL, Rosendahl PP. Immunity: Pathophysiology Adaptations and Alterations in Function. Philadelphia: Lippincott; 1992. . Centers for Disease Control and Prevention. (1994). 1994 revised classification system for human immunodeficiency virus infection in children less than 13 years of age. MMWR Recomm. Rep. 1994;43(RR-12):1–10. 4. Lusso P. (2006). HIV and the chemokine system: 10 years later. EMBO J. 2006;25:447–456. 5. Montero J, Nadler JP. Pathophysiology of HIV Infection. In HIV/AIDS Primary Care Guide. Crown House Publishing L imited; 2005:1–14. 6. Noble R. Introduction to HIV types, groups and subtypes. http://www. avert. org/hiv-types. htm. Accessed June 24, 2009. 7. Azevedo-Pereira JM, Moniz-Pereira J, Santos-Costa Q. HIV-2 infection and chemokine receptor usage— clues to reduced virulence of HIV-2. Curr. HIV Res. 2005;3:3–16. 8. Klatt EC. Human Immunodeficiency Virus. Pathology of AIDS. University of Utah; 1999. 9. Ungvarske PJ, Flasderud HJ. Overview and Update of HIV/AIDS: A Guide to Primary Care and Management. Philadelphia: W. B. Saunders; 1999. 10. U. S. Department of Health and Human Services, National Institutes of Health, National Institute of Allergies and Infectious Diseases. Understanding the Immune System and How It Works. Bethesda, MD; 2007. Advanced Signs and Symptoms of HIV (Clinical Stage 3) HIV-infected patients with weakened immune systems can develop life-threatening infections. The development of cryptosporidiosis, pulmonary and lymph node tuberculosis, wasting, persistent fever (longer than one month), persistent candidasis, recurrent bacterial pneumonia, and other opportunistic infections is common. These patients may be wasting, or losing weight. Their viral load continues to increase, and the CD4+ count falls to less than 200-349 cells/? L in children older than 5 years. Clinical Stage 4 Patients with advanced HIV disease, or AIDS, can continue to develop new opportunistic infections, such as Pneumocystis jirovecii pneumonia (formerly Pneumocystis carinii pneumonia), cytomegalovirus infection, toxoplasmosis, Mycobacterium avium complex, cryptococcal meningitis, progressive multifocal leukoencephalopathy, Kaposi sarcoma and other infections that commonly occur with a severely depressed immune system. The viral load is very high, and the CD4+ count is less than 200 cells/? L in children older than 5 years. At this point in the disease course death can be imminent. 14

Marketing Project Essay Example

Marketing Project Essay Example Marketing Project Essay Marketing Project Essay Executive Summary Wentworth Industrial Cleaning Supplies is an organization whose potential is currently clouded by their lack of competitive strategy. Through analysis of their current situation, several key issues were identified: * Market Research is ineffective and unimplemented * Product line ignores majority of market * Roles of key personnel are illogical and inefficient * Relations with distributors are hostile and unsustainable * Profits and growth is stagnant in an advancing industry * Communication mechanism is fragmented After evaluation of the alternative courses WICS has for consideration, recommendations to address and rectify each issue were chosen. Through assigning specific tasks to the marketing department and enabling a communication mechanism along the personnel chain, objectives and opportunities can be shared. By making strategic role changes to the territorial and area managers, redundancies can be eliminated and the goal of developing and maintaining a unified network can be achieved. Through the addition of a big-tickets sales team and the outsourcing of economy chemical for use in private labels, WICS can gain a larger market share and sustain increased profits for years to come. In combination, these actions provide the basis for the development of a large-scale, well-branded organization with responsiveness to growth and opportunities in the market. Issues with Current Operations Market Research WICS lacks the marketing insight to target clients appropriately. As a solely premium brand, market research is crucial to customer perception and increasing the 40% share of customers willing to pay premium prices for WICS products. Moreover, new lines or line extensions are difficult to launch when there is no market research. In an evidently growing industry, the inability to provide an appealing value proposition to 60% of the customers has caused WICS to halt sales growth and struggle to keep its current market share. Furthermore, the justified frustrations of the area managers cannot be resolved until WICS is able to give them appropriate job descriptions and requirements contingent on the nature and changing behaviour the industry derived from market research. Product Line â€Å"Only 8 percent of customers describe their experience as superior, yet 80 prevent of companies believe the experience they provide is indeed superior† Roger J. Best Current Segments Opportunity for Growth Distributors claim â€Å"WICS products are basically no better than anyone else. This is a dangerous mentality when they are currently responsible for actively promoting and marketing WICS products. Their products, priced in the premium category, are reliant on promotion to build a strong perceived value. Furthermore, only 40% of consumers are willing to pay premium prices, leaving 60% of end users uninterested in WICS. This presents a unique marketing challenge for WICS- the need to expand to reach a greater s hare of the market while upholding their image as a premium manufacturer. Role Distribution For managers, a lack of job autonomy creates a feeling of resentment towards superiors and inhibits productivity. (Quote OB Book). Furthermore, the current incentive program stresses disproportionate selling techniques by placing heavy emphasis on hunting at the expense of neglecting farming attained accounts. This focus on hunting new accounts has resulted in acquiring unprofitable accounts that do not allocate a sufficient amount of their total purchases to WICS products. It is expensive and frustrating for distributors to maintain these clients, and they ultimately add little value to the corporation. Finally, the allocation of area manager duties (exhibit 6) results in low productivity by emphasizing ineffective selling techniques and needlessly excessive time spent on demonstrations Communication Discrepancies Internal communication is crucial for any functioning business competing in any industry. The marketing vice president de-motivates his staff members by projecting low confidence in their abilities and using threatening tactics to scare employees into scrambling to do their work for the sake of maintaining their jobs (OB BOOK). Moreover, SSDs feel neglected in the sense that they lack direct communication to management level WICS employees and/or the ability to relay their concerns/recommendations via area managers. Distributor Relations The perceived subjection to â€Å"pressure tactics† and the lack of belief in WICS products amongst distributors is an ongoing promotional issue that must be immediately addressed. As well, the combination of WICS current high minimum buy-ins and lack of communication between SSDs and management level WICS staff has yielded an environment retardant to growth for WICS products. WICS’ refusal to grow geographically with its respective SSDs is limiting both to SSD relations and company growth. Requiring SSDs to beta test WICS products is detrimental to both WICS brand image and once again, SSD relations. Because the products currently require timely demonstrations, high sales costs for SSDs have occurred. Recommendations Additional Duties for Territorial Managers The territory managers will be responsible for hunting new distributor clients that would work with WICS and assigning them to an area manager. The territory manager will allocate the new distributor to a manager in accordance with the ratio that we have in place: 1 Territory Manager: Area Managers – 4:1 Area Manager: SSD’s 2-4:1, based on size of SSD 1 Territory Managers: Area Manager – 4:1 4 2-4 Teea Manager – 4:1 Maintaining this ratio will allow territory managers to operate more effectively. Reallocation of Area Managers’ Duties Currently, the Area Managers’ roles and expectations are outdated and ineffective. Their duties need to be reallocated to give more autonomy to the Area Managers when hunting new clients. In this way, they can use their discretion when choosing which methods they prefer to use with their clients, based on their skills and what they feel is most effective. We propose they no longer push the demonstrations onto the SSDs, and instead offer sample Kits that the SSDs would give out to customers to sample the product before making their buying decision. Consequently, the Area Manager will cut this time in half and instead give information sessions for SSD staff about the DIY Sample Kits, negotiate lowering margins, and implement new products. Another 20% of the Area Managers’ time will be spent on the relationship with the SSD’s. Creating and Motivating Personnel Network WICS’ distributor network will be more interactive, fostering communication amongst all three key players- SSD’s, Territorial and Area managers. The Area managers will visit distributors on a weekly basis to receive feedback, address concerns, and discuss routine business logistics. In addition, distributors will receive a bi-monthly visit from their allocated territory manager, who will ensure that any feedback on the effectiveness of the area manager is heard and acted upon. Similarly, there will be weekly communication between territory managers and area managers. This will allow any corporate objectives to be reached, and to share ideas on tactics for reaching sales goal. The evaluation of the SSD’s roles will be done by area managers, with autonomy to create and execute incentive programs within a given budget. Although area managers will have the ability to identify the measurement tactics and rewards for managers, the general incentive drivers will be determined based on sales goals by the marketing department and manager. This will allow the company to emphasize sales of particular products, balance goals for growth with those of customer maintenance, and deliver a customizable incentive program to distributors that will ensure a strong partnership. For Area Managers, incentive programs will be designed and measured by Territorial managers. In a similar fashion to the distributor incentive structure, this method will allow WICS to balance their need for resonant, customized rewards with their efforts to align progress with corporate objectives. Drivers for measuring area manager success may include looking at feedback from SSD’s to evaluate communication and negotiation skills, looking at results in efforts to attract new customers, and evaluating their ability to foster an effective and profitable network through working with their subordinates and superiors on the WICS personnel chain. As area managers are a key link between WICS management and their front-line sales force, it will be essential to harness the competitive nature of the individuals working as area managers through recognition and reward. As a result, winners of incentives and titles will be well-publicized with the corporation, and the objectives by which measurement and designation of winners are achieved will be constantly re-evaluated to ensure that it is meaningful. Providing Raw Materials for Private Labels Only 40% of end users are willing to pay premium prices leaving the majority of customers within the janitorial cleaning supplies industry unaddressed by WICS. In order to maintain active growth, WICS needs to address the unserved 60% of the market. There are two typical ways to approach this problem ) create economy product lines 2) create a flanker brand The first solution not only poses the problem of diluting WICS premium brand image, but also presents the problem of cannibalization. The second approach, although separating WICS from the name of its economy brand, still faces strong opposition as SSDs will be hesitant to hold products that are directly competitive with their private labels. A more innovat ive and successful approach is to being providing SSDs with competitive incentives to sign over their private label outsourcing to WICS. In doing so, WICS will promise to match or provide SSDs a lower price for the raw core materials required to create their private labels. WICS will not pursue/take over any private label outsourcing activities if the prospects prove to be unprofitable, however it will strive to reap economies of scale in the production their raw chemicals, and to strengthen their vested interest in the market segments by sharing in the growth and profitability of the economy lines of the distributors. Hunting and Farming Tactics for Market Share Development WICS will be most successful in its business development efforts if it targets customers using the most successful tactics. For new, high-end customers willing to pay premium prices, tactics such as spotters, use of personal network, research and cold-calling can be used. This will allow WICS to identify potential large-contract clients and either reach out to them via connections or cold-call and pitch their value proposition. Examples of events in which WICS can capitalize on the need for industrial cleaning products include: * Sporting Events- 1992-1996 is the most concentrated time in history for the Olympic games- with two games in 1992, and two more in 1994 and 1996, WICS has the opportunity to capture huge contracts and expand into other sporting event clients * Airlines- in 1992 alone, 86 new airlines were launched. WICS should aim to approach start-up companies in travel and high-growth tech segments for potential contracts * Malls- with Mall of America opening in 1992, WICS should capitalize on the opportunity to develop a sales pitch aligned specifically with the needs of retail malls. Through the sale of chemicals to distributors private labels, Wentworth now holds a vested interest in 100% of the industry. As a result, they have the opportunity to pair with SSDs to farm current customers and pitch a full-package contract in which the SSD private line and WICS products cover all the needs of the client. Special Sales Force Big Ticket Clients With the aforementioned large-scale contract opportunities, WICS needs to devote highly effective salespeople specifically to the attainment of big-ticket sales. The strategy behind acquiring such â€Å"big-ticket† clients involves partnership with market leaders from the other three segments in the institutional maintenance chemical market (EXHIBIT 1). Through partnership, it becomes possible to offer such big clients with massive cleaning requirements in every segment with relatively cheap product bundles. Product bundles are able to be priced as low as necessary to entice clients to pursue them exclusively because of economies of scale. Market research would determine viable market leaders that suit WICS brand image to be pursued by WICS Special Sales Force. The Special Sales Force would initially comprise of two management- level staff members (SEE NEW ORG. CHART) who strictly work towards pursuing the logistics of â€Å"big-ticket† clients. This number can expand as WICS grows contracts and profitability in new sales segments. Further advantages of creating product bundles with the other three respective segments in the institutional maintenance chemical market is utilizing partners as spotters. Spotter perks involves exchanging market research, customer information, and referring prospective customers. Furthermore, some big tickets clients may present unprecedented marketing opportunities for WICS. For example, if the product bundles are successful in attaining most of the purchasing of one or both of the Olympic games, WICS could always offer further discounts in exchange for soft advertising such product placement. Implementation of Strategic Recommendations: * Within the next 6 months: The measures taken during the next six months are going to lay the groundwork for WICS to become more efficient, reduce costs, forge better relations with SSDs and staff, and increase market share. Firstly, area and territory managers need to be retrained into their new roles with in the company. This training needs to be carefully implemented, and WICS needs to ensure that the staff are happy with the changes and behind the revamped corporate strategy. Once staff understand their new roles, the infrastructure and products must be ready. The chemical products need to be available for sale as soon as possible for the area managers to start sales. Area managers need to get to work on private label sales as quickly as they can in order to begin penetrating the market. As well, the do-it-yourself kits need to be made and sent out to distributors so that customers can begin testing WICS products without the distributors and area managers having to worry about the timely demonstrations. With the new roles in place, the feedback mechanism will immediately begin so that the distributors begin to feel the shift in customer focus that WICS will be adopting. With the increased support from all WICS staff, and the lower cost of sale, this will motivate the distributors to push WICS products more, without the pressure from area managers, and will grow market share and sales for WICS. * Long term goals: As adoption rates of WICS raw chemicals increase, the company should work towards an objective of serving products in 100% of the industrial cleaning market’s segments. This will be achieved by a combination of increased sales in the WICS line, representing 75% of the market, and the addition of private label products which serve the remaining 25%. This goal should be attained within the next three years, and the mechanism for its realization is the ability of area managers to negotiate and finalize outsourcing contracts with their distributors.